As harm reduction workers on the frontlines fight Baltimore’s unprecedented overdose crisis, some organizations fear that funding cuts and punitive drug policies under President Donald Trump could hamper their progress.
Trump struck fear into such nonprofits after issuing a federal funding freeze on grants and loans last week, a maneuver meant to force organizations to adhere to the nascent administration’s far-right doctrines. Although the order is now tangled up in the courts, harm reductionists’ concerns are compounded by Trump’s promises to ramp up the criminalization of those they serve — an indicator he plans to fan the flames of the racist War on Drugs at a time when fatal overdose rates are finally slowing.
“All of the moves this administration is talking about implementing spell death for the people we serve,” said Candy Kerr, spokesperson and policy advocate for the Baltimore Harm Reduction Coalition.
“Increased criminalization forces people into the shadows, and defunding programs takes resources and supplies out of people’s hands. Cutting funding would dramatically affect, if not completely shut down, our services. Not only would overdose deaths increase, but HIV and Hep C transmission would increase, syringe litter [would increase], etc.”
The BHRC, one of numerous nonprofits serving drug users in Baltimore, provides a wide range of services critical to the city’s harm reduction infrastructure, including naloxone distribution, training and a syringe service program. The initiatives have been proven effective in combating overdose deaths.
In his two weeks in office, however, Trump has raised red flags for nonprofits serving vulnerable populations. Last week, the White House’s Office of Management and Budget issued a memo ordering a temporary freeze of federal funds for grants and loans, on which many nonprofits rely.
After a federal judge blocked the order, the administration rescinded the memo but insisted it still planned to pause funding. The order was further delayed after a federal judge in Rhode Island issued a temporary restraining order in response to a 22-state lawsuit that included Maryland.
Though now in limbo, the freeze threatens trillions of dollars in funding — including money that helps harm reduction organizations save the lives of those who use drugs. Local nonprofits vary in how much federal funding they receive, but any funds diverted to criminalization efforts rather than harm reduction could kneecap efforts on the ground.
Behavioral Health System Baltimore, a nonprofit providing an array of harm reduction services through its Bmore POWER team, receives a mix of federal, state and philanthropic funding budgeting $60 million annually, said Adrienne Breidenstine, the organization’s spokesperson.
“Any change in funding or policy at the federal level has the potential to impact access to services, including harm reduction services,” Breidenstine said. “A reduction in funding or new limitations on what federal funds can be used for could change the programming we currently offer, reduce it, or eliminate it.”
“Treating [drug use] first and foremost as a crime to be punished is contrary to everything that harm reduction programs seek to do. Harsh criminal penalties push people who use drugs into the shadows and make them fearful to engage in services. This approach reduces trust and harms the relationships needed to help someone address problematic drug use.”
At Health Care for the Homeless, a local nonprofit, a funding pause could hurt more than just its harm reduction initiatives; it could also hinder its services to Baltimore’s unhoused population, who are more likely to have substance use disorders.
“Making America healthy starts with keeping people alive,” said CEO Kevin Lindamood. “Harm reduction efforts have been embraced as life-saving and cost-effective responses to the disease of addiction by both Democratic and Republican administrations. We would hope that this administration and any administration would come to see the value in reducing overdose deaths and keeping people alive long enough to engage them in meaningful and lasting treatment.”
“A just and fiscally responsible society does not criminalize its most vulnerable members; it invests in solutions that promote dignity and stability,” added Lawanda Williams, the organization’s chief behavioral health officer. “We should focus on safe and affordable housing so that nobody has to live their private lives in public. And supportive services to help address people’s basic needs.”
Trump, who has proudly pushed for a heavy-handed, punitive approach to drug policy, has said he instead will prioritize law enforcement efforts that historically have only worsened the decades-long drug war. He’s pushed for the death penalty for those who sell drugs and has threatened other nations with tariffs to allegedly combat drug trafficking.
The rhetoric and foreign policy decisions echo those of his first term, when he largely focused on policing and xenophobic policies to address the overdose crisis. The strategy ultimately failed, as evidenced by the fact death rates continued to rise throughout his presidency.
In a November report, Regina LaBelle, director of O’Neill Institute for National and Global Health Law, said Trump's second term could likely be the same, warning about the potential implications of Trump’s policies.
LaBelle wrote that multiple factors will be at play, "including the role Robert Kennedy Jr. will play in addiction and public health policy, as well as questions over the continued existence of the Affordable Care Act."
"Ultimately, the next Trump administration will likely continue to focus on law enforcement solutions to drug policy, particularly those that connect drug treatment with criminal justice approaches," LaBelle wrote. "Look for an emphasis on drug policy through a criminal justice lens, rather than on public health initiatives that include low barrier options for services in the community."
National nonprofits fighting the drug war have also sounded the alarm about the next four years. The Drug Policy Alliance last week urged people to contact their representatives in Congress, saying “Trump's proposed cuts on federal grants threatens addiction treatment, housing, healthcare programs, and other services that save lives.”
The concerns come at a crucial juncture in the overdose crisis. In 2023, annual overdose deaths in the U.S. dropped for the first time in five years. Locally, preliminary data shows Baltimore seems to finally be experiencing a similar decrease, with local experts expressing cautious optimism.
City officials also hope a windfall of funds from recent opioid settlements will turbocharge their efforts.
Baltimore is involved in an ongoing lawsuit against two opioid distributors, but it’s already slated to receive nearly $670 million over the next 15 years. The ongoing lawsuit against McKesson and Cencora, formerly called AmerisourceBergen, could bring in billions more.
That money could buoy harm reduction initiatives if federal funding falls through. However, it’s not just existing programs under threat — the new administration could prove to be a death knell for new, more progressive initiatives advocates have wanted for years. That includes long sought-after overdose prevention centers, or OPCs.
OPCs, which enable people to use drugs in safe spaces overseen by medical professionals, have been proven to prevent overdose deaths and reduce public drug use. Organizations have been fighting to implement them in Baltimore for years, though legislation in the state General Assembly has repeatedly died in committee.
Lawmakers are again trying to implement OPCs statewide, and Baltimore Mayor Brandon Scott has named them a “legislative priority.” He hasn’t indicated he would follow the lead of New York City and implement them without state laws in effect, but any efforts could face roadblocks under Trump.
In Trump’s first term, the Department of Justice blocked a nonprofit called Safehouse from opening a center in Philadelphia, much to the chagrin of advocates and public health experts.
Still, organizations in Baltimore are determined to carry on despite potential threats at the federal level. Bakari Atiba, community leadership coordinator at Charm City Care Connection, said the nonprofit will continue focusing on saving lives.
There are concerns the new administration could thwart harm reduction strategies such as OPCs, he said, but the organization must nevertheless continue to build upon current services such as its drop-in center, naloxone training and syringe service program.
“Relationship building is key,” Atiba said. “We can offer all the services in the world; all the things that are happening politically can continue to happen. Our strategy is to build relationships and trust with the people and the community we serve. We’re already locked in with the people, and they can tell us what they need and how to best continue supporting them in dark times. And we’ll figure it out.”
“No matter what happens up top, we still got to keep our feet to the ground on the bottom.”
Editor's note: This article will also be published by the Baltimore Beat as part of a content-sharing partnership. Check it out here.
Comments